Employee Notice Of Discipline
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3EMPLOYEE NOTICE OF DISCIPLINE
Employee
Work Location
Date of Discipline Action Given
Employee ID #
Date of Occurrence
Supervisor Issuing Action
Violations
Attendance
Vile, Foul or Abusive Language
Violation of District Policy:
Unauthorized Absence
Safety/Carelessness
(indicate policy)
Tardiness
Willful Damage to District Property
Insubordination
Harassment
Conduct
Falsification of Documentation
Endangerment to others
Other
Violation Statement
(attach any supporting documentation)
Date of Violation:__________________
Place of Violation:________________________________________________________________________
Statement of Voilation:____________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_____________________________
______________
_________________________________
Signed by Supervisor Issuing Action
Date
Position
Disciplinary Action
Oral Reprimand
Written Reprimand
Sent Home w/out Pay
Suspension with out pay ___ days
Administrative Leave w/Pay
Recommendation for Termination
Corrective Actions to be Taken
Corrective Actions/Timeframe:_______________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
I have read this Notice of Discipline and understand it. (Employee needs to sign each page of supporting
documentation also to verify they have been made aware of that)
Employee refused to sign this form and all attached documentation
Employee’s Signature___________________________________________
Date__________________
Supervisor’s Signature___________________________________________
Date__________________
Witness’s Signature_____________________________________________
Date__________________
The above disciplinary action has been noted and this form will be made part of the above employee’s
permanent file, as of this date.
________________________________________
________________________________________
CE Program Coordinator
Date
Department Head
Date
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